Behavioral Therapy Puts Insomniacs to Sleep

Most people need only leave enough time in their busy schedules to get a good night's sleep. For up to 5 percent of the population, though, the night is full of wakeful moments, owing to a sleep disorder known as persistent primary insomnia (PPI). The most common treatments offered to PPI patients¿most of whom struggle not with falling asleep initially but with staying asleep through the night¿are sedative-hypnotics and antidepressants. But many experts feel that such drugs don't represent a viable long-term solution. New research, presented today in the Journal of the American Medical Association (JAMA), suggests that behavioral therapy instead may be the answer.

Medical psychologist Jack D. Edinger of Duke University and his colleagues conducted a two-and-a-half-year study of 75 adults suffering from sleep maintenance insomnia in order to assess the efficacy of a form of cognitive behavioral therapy (CBT), as compared with relaxation therapy and placebo therapy. The CBT used in this case combined cognitive therapy, such as teaching subjects to think about sleep in a more constructive way, with strategies to improve their sleep habits¿namely getting out of bed at the same time each day and eliminating napping. The researchers found that those subjects receiving CBT experienced a 54 percent reduction in their wake time after sleep onset. Relaxation therapy and placebo therapy recipients, in contrast, experienced only 16 percent and 12 percent reductions, respectively.

"This study shows quite clearly that a cognitive behavioral insomnia therapy can be effective for people who have difficulty staying asleep at night," Edinger asserts. "Many patients were able to reach fairly normal levels of sleep with this treatment and without the use of sleeping pills, and the results lasted through six months of follow-up."